Provider Demographics
NPI:1992013676
Name:NORTH SHORE LONG ISLAND JEWISH MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH SHORE LONG ISLAND JEWISH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELNATANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:718-470-7030
Mailing Address - Street 1:7576 184TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1715
Mailing Address - Country:US
Mailing Address - Phone:718-674-6456
Mailing Address - Fax:
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1402
Practice Address - Country:US
Practice Address - Phone:718-470-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH SHORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010047282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital